Professional Documents
Culture Documents
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Laboratory examination for Infection
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Routine examination
HEMATOLOGY :
Blood cell count complete blood cont (CBC)
Hemoglobin concentration (Hb)
Platelet count
Extracellular microorganism
Destruction of RBCs
Lysis ANEMIA
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Hemolytic anemia in parasites infection
Infected cell
Lysis ANEMIA
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Anemia of Chronic Disease
ACD is associated with an underlying disease
(usually inflammation, infection, or malignancy),
but is without apparent cause (not due to a lack
of the nutrients iron, vitamin B 12, or folic acid)
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Anemia of Chronic Disease
Pathophysiology:
Erythropoesis suppression
Chronic inflammatory process secretion of TNF
& IL-1
Lack of iron for Hb synthesis
Lactoferrin release from granules of neutrophils
Lactoferrin competes with transferrin for iron
Decreased RBC survival
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Routine examination - hematology
Reference range :
adult = 4000 -11.000 cells/L
child = 4500-17.000 cells/L
newborn= 6000-30.000 cells/L
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Kinetics of Leucocyte
Storage pool
Circulating pool
Input
Output
from
to tissue
marrow
Marginal pool
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WBC
Pathology
Leukocytosis Leukopenia
WBC > 11.0 (x 109/L) WBC < 4.0 (x 109/L)
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Routine examination - hematology
Blood smear :
- relative number
- leukocyte immaturity
- morphologic abnormality
Abnormality: Quantitative
Qualitative
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Classification of Leucocytes
Granulocyte Non-granulocyte
Neutrophil, Monocyte
Eosinofphl, Lymphocyte
Basophil
Polimorfonuclear Mononuclear
Neutrophil, Monocyte
Eosinofphl, Lymphocyte
Basophil
Immunocyte
Phagocyte Lymphocyte
Neutrophil
Monocyte
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All white blood cells originate from the bone marrow
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Blood cells migrate through blood and lymph nodes or home to tissues
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Cells in blood circulation
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Resting lymphocytes are round cells with a large nucleus
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Differential cell count
Refference range:
Polymorphonuclear
neutrophils : 50 70 %
Bands : 05 %
Lymphocytes : 18 42 %
Monocytes : 1 10 %
Eosinophils : 14 %
Basophils : 02 %
NEUTROPHILIA
3 major cause : infection,
inflammation, malignancy
Severity of neutrophilia in
infection depend on:
- virulency of organism,
- age : child >
- patient immunity:
immunocompromised host
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Quantitative abnormality
Causes of neutrophilia
1. Bacterial Infection
2. Toxic agent
3. Metabolic: uremia, eclampsy, metabolic
acidosis
4. Drugs & chemicals: mercury, digitalis, steroid
5. Physic & emotional stimuli
6. Tissue damage & necrosis: myocardial infarct,
wound, neoplastic diseases
7. Hemorrhage: especially intra serous cavity
(peritoneal, pleural, joint space, subdural)
8. Hematological diseases: leukemia.
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Qualitative Abnormality
Shift to the left or right:
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Bain, 2002. Blood Cells, A Practical Guide,3rd ed, Blackwell Publ, UK
Qualitative abnormality
vacuolisation
vacuolisation
Toxic granulation
Toxic Granulation
vakuolisation
Bacterial infection
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Qualitative abnormality
Toxic Granulation
Stimulated by organism or antigen
Color of granule: dark blue-blackish
Profound toxic granulation worse prognosis
Vacuolisation of cytoplasm
phagocytosis process
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Neutropenia
Netropenia lekopenia
Agranulositosis: severe netropenia
Causes of netropenia:
Viral infection
Certain Bacteria: Tifoid/ paratifoid
Severe infection
Immune reaction: autoimmune/ drug induced
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EOSINOPHILIA :
1. Parasite investation
- correlate with killed parasites
- eosinophyl attracted to parasite will be killed
by degranulation process
2. Allergy/ hypersensitivity
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EOSINOPHILIA :
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Lymphocytosis
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Lymphocytosis with variant lymph:
- Mononukleosis infecsiosa (var lymph 40%),
acute hepatitis, citomegalovirus (CMV)
- measles, pneumonia viral, rubela relatif
- Non viral : Tuberculosis, syphilis, malaria,
typhus, diphteria, toxoplasmosis
Lymphocytosis without var lymph:
asimptomatic viral inf., diarrhea, resp. inf
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Virus Infection
MONONUKLEOSIS
INFEKSIOSA (MI)
cause: virus Epstein-
Barr (EBV)
Lekositosis with
limphocytosis, dan
atypical lymphocyte
Kissing-cell
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Dengue virus infection
Reactive Lymphocyte
Blue cytoplasm-
Lymphocyte
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Monocyte
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MONOCYTOSIS
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Routine examination - hematology
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Normal sedimentation Increase Sedimentation
infection
Polisitemia : AE
Dekompensasi myocardial infarct
jantung Rheumatic fever
Sickle sel anemia, Malignancy with necrosis
sferositosis
Neonatus Active tuberculosis ,
tissue destruction
Surgery Trauma, shock
Hiperglobulinemia
Pregnancy
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C-REACTIVE PROTEIN (CRP)
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CRP increase in :
Infection:
Lower in viral compared to bacterial infection
Useful to monitor disease activity
Inflammatory disorders:
Earlier,more intense increase than ESR
Dissaperance of CRP precedes the return to normal
of ESR
Tissue injury or necrosis
AMI : appears within 24-48 hrs
Malignant disease, Following surgery, burns
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